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Abstracts / Contraception 76 (2007) 157–178
Results: Over 93% of women in both arms had successful abortions without recourse to surgical intervention, with a statistically higher success rate in the sublingual group (98.7% vs. 94.0%, p=.005). Greater than 91% of women in both groups reported being either satisfied or very satisfied with the method and over 80% reported that side effects were acceptable or very acceptable. Conclusion: Sublingual misoprostol 400 μg used after mifepristone 200 mg is significantly more effective than oral misoprostol 400 μg taken after mifepristone200 mg, and as acceptable as oral misoprostol in inducing abortion in women up to 63 days' gestation. Further studies are needed to assess the efficacy of these routes at later gestational ages, particularly between 56 and 63 days. O10 KNOWLEDGE AND UNDERSTANDING OF MENSES INHIBITION OR REDUCTION IN WOMEN AND PHYSICIANS
Results: Fifty-eight percent of mothers reported that their pregnancies were intended (wanted to be pregnant then or sooner), 31% mistimed (wanted later) and 11% unwanted (did not want to be pregnant then or at any time in the future). Among mothers with unwanted pregnancies, 86% did not take folic acid daily, 44% initiated prenatal care after the first trimester and 24% smoked during pregnancy. Postpartum, 37% of these mothers did not breastfeed, 50% did not place their babies to sleep on their backs, 30% smoked and 27% reported depression. Significantly lower percentages (pb.001) of mothers with mistimed or intended pregnancies reported these unhealthy behaviors. Fiftytwo percent of mothers with unwanted pregnancies used birth control at the time of conception; of the 48% who did not use birth control, 37% thought they could not get pregnant. Ten percent of mothers with unwanted pregnancies delivered low birth weight babies (b2500 g) as compared with 7% of mothers with intended pregnancies. Conclusion: The burden of mistimed and unwanted pregnancy is still large. Contraception counseling and pregnancy planning can help reduce unintended pregnancies and positively affect maternal and infant health.
Barnhart K University of Pennsylvania, Philadelphia, PA, USA
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Karcewski C, Marren A
THE COST OF INACTION: THE ECONOMIC CONSEQUENCES OF DENYING UNDERINSURED WOMEN POST PARTUM STERILIZATION
Introduction: The knowledge and understanding of women and their health care providers (HCPs) regarding the inhibition of menses through continuous oral contraceptive (OC) use was evaluated in two large surveys.
Rodriguez MI Oregon Health and Science University, Portland, OR, USA
Materials and Methods: The Consumer Attitudes and Use (CAU) study randomly and representatively enrolled 500 women ages 18–49 years via the Internet and asked 51 multi-part questions regarding their attitudes towards and usage of contraception. The Physician Attitudes and Usage (PAU) study enrolled 300 HCPs in a full-time office practice (N30 h/week) who were b60 years of age and asked similar questions.
Jensen JT, Edelman AB, Wallace N
Results: In the CAU study, 63% of women reported being “somewhat” or “extremely” interested in not having a period, but only 17% of HCPs in the PAU study reported that their patients indicated they did not want a period. While only 20% of women in the CAU study reported they “strongly agree” or “somewhat agree” that having their period is not medically necessary, 97% of HCPs in the PAU study reported that continuous OC use is medically acceptable (“strongly agree” or “somewhat agree”). Few women in the CAU study (12%) reported talking to their HCP about eliminating or reducing their periods; of these, 71% reported that they raised the topic. However, 80% of HCPs in the PAU study reported mentioning continuous OC use when discussing contraceptive options; when continuous OC use was discussed, 77% of HCPs reported that they raised the topic. Conclusion: Women and their HCPs have different understandings of the medical implications of menses inhibition, and women may be receiving insufficient information. O11 UNINTENDED PREGNANCY AND ASSOCIATED PERINATAL BEHAVIORS AND OUTCOMES Cheng D Maryland Department of Health and Mental Hygiene, Baltimore, MD, USA Horon I
Introduction: Mistimed and unwanted pregnancies may have an adverse impact on maternal behaviors as well as infant outcomes. Materials and Methods: Data were obtained from the Pregnancy Risk Assessment Monitoring System (PRAMS) of Maryland 2001–2005 births. During this period, a stratified random sample of 7381 mothers completed the PRAMS questionnaire between 2 and 6 months after delivery. Percentages and p values of cross-tabulations were calculated using SAS-callable SUDAAN.
Introduction: To determine the impact on migrant workers covered by state-sponsored obstetrical insurance (CAWEM) of a 2004 university hospital policy change eliminating reimbursement for post partum tubal sterilization following vaginal delivery only, we examined rates of tubal ligation following vaginal (PPBTL) and cesarean (CSBTL) delivery, and compared these to a Medicaid (OHP) population unaffected by the policy change. Materials and Methods: Medical and billing records were reviewed for patients who delivered at Oregon Health and Science University hospital between January 1, 2000, and December 31, 2006. Data examined included insurance, delivery type and sterilization status. Rates of PPBTL and CSBTL for CAWEM and OHP were compared before and after the policy change. Results: A total of 3612 OHP and 4220 CAWEM patients delivered in the 4 years before and 1628 and 2066 in the 2 years after the policy change. The incidence of PPBTL among CAWEM patients following NSVD dropped from 316/3201 (9.9%) pre-policy to 14/1488 (0.9%) post-policy change (pb.01). Concurrently, CSBTL among CAWEM patients increased from 181/ 975 (18.8%) pre-policy to a post-policy rate of 147/622 (23.5%, p=.03). Notably, no significant change in PPBTL (236/2713, 8.7% pre; 103/1118, 9.2% post; p=1.0) or CSBTL (206/899, 22.9% pre; 117/510, 22.9% post; p=.617) was observed in the control OHP population.
Conclusion: Eliminating payment for tubal ligation following vaginal delivery results in a substantial reduction in the number of parturients receiving a PPTL, and a marked increase in the number choosing cesarean section BTL. O13 EMERGENCY CONTRACEPTION SERVICES FOR ADOLESCENTS: A NATIONAL SURVEY OF CHILDREN'S HOSPITAL EMERGENCY DEPARTMENT DIRECTORS Kavanaugh ML University of Pittsburgh, Pittsburgh, PA, USA Gold MA
Introduction: Adolescents' need for emergency contraception (EC) may be higher than adults' because of their inconsistent patterns of sexual